Doulas and Labor Support

Dominique W. Brooks
Doulas

The task of labor can be challenging and grueling, no matter how many times a woman has gone through it. Having someone available to offer encouragement, to help with breathing and other comfort techniques, and to assist with changing positions can make the process a more positive experience for the laboring woman. Labor support can come in different forms and can be given by a non-professional like a husband or significant other or a professional like a doula or other official coach.

A Doula's Role in Labor

According to research, women with doulas need fewer cesareans, less pain medicine, less instrumental births (forceps and vacuums), and less pitocin augmentation. They also report shorter labors, more pleasant birth experiences, and better bonds with their new babies. Women with professional labor coaches may have an easier experience with breastfeeding and continue breastfeeding longer than women who did not have a doula.

What a Doula Does

A doula offers suggestions that can change the progress of your birth. She may offer birthing ball techniques, aromatherapy, acupressure, and a 'big bag of tricks.' She reassures the laboring family and can help with fears or emotional times. She can point out interventions and explain them in layman's terms. A good professional labor coach does whatever you need her to do. She offers comfort measures like the following:

  • Breath coaching
  • Hot/cold compresses
  • Position suggestions
  • Massage
  • Other non-medical pain relief measures

Many doulas receive training in labor massage, but some, called massage doulas, are certified massage therapists as well. Labor massages could involve different parts of the body like the shoulders, lower back, hands, and feet. You can discuss levels of massage training with your doula.

What a Doula Does Not Do

Doulas are not medical professionals. A professional labor coach can explain what dilation, effacement, and station mean. She can give pros and cons to interventions such as pitocin and an epidural. However, she cannot make decisions for a laboring woman.

She should never perform medical procedures, such as vaginal exams, blood pressure checks, or fetal heart checks. She should not ever send a doctor from the room or threaten to leave if the mom gets an intervention. Her job is to do whatever the mom needs her to do, even if that means supporting interventions she personally disagrees with.

Doulas Aren't Just for Natural Childbirth

A lot of women know from the start they want an epidural or narcotics, or they may not be sure what type of pain relief they will require. A doula can still help you with comfort techniques until you get your epidural and provide emotional or informational support. She can help you when it comes time to push and provide assistance with breastfeeding after your baby is born.

When you interview for a professional labor coach, you will want to find one who understands what you want and will support your choices. A good professional labor coach will not try to talk you into a natural childbirth if that's not what you want.

How Doulas Work with Partners

A good professional labor coach will work with your partner, not against him. She will probably have met with you and your partner before the birth to determine how much your partner wants to be a part of the birth. She may offer your partner suggestions on ways to help, if he wants to help. During the birth, she will remind your partner to eat, rest, and take restroom breaks. Her job is to support not only you but your partner as well.

A good doula does not replace the partner. She cannot share the love or connection you two share. Your partner will show his love and give his strength to you during your labor. Your professional labor coach cannot do this, nor should she try.

Labor Support from a Partner or Friend

Although a professional doula offers lots of experience and a different perspective, you may feel more comfortable receiving labor support from you partner, a friend, or a family member. This decision is completely up to you. Your personal labor support person can prepare for the big day in lots of ways:

  • He or she can take a childbirth class with you, such as Lamaze or the birth preparation class at your local hospital.
  • He or she can discuss your birth plan with you to make sure you have the same vision for your child's entrance into the world.
  • He or she can accompany you on a tour of the hospital, so you'll both know what to expect.
  • He or she can pack a bag of comfort measures for the birth, including massage oil, relaxing music, inspiring photographs, and other helpful items.

Choosing a Professional Labor Coach

If you do decide that you'd like a doula or professional coach to help you during labor, it's important to choose carefully.

Finding a Doula

Most hospitals do not offer doulas on staff, though there are exceptions. Professional labor coaches are privately hired and contracted with the pregnant family, not with your care provider.

There are many national doula organizations that offer certification programs for doulas. The certification process varies depending on the organization, but usually, it includes reading, a training requirement, reviewed births, written essays, and possibly a written test. National organizations include DONA, CAPPA, ICEA, Childbirth International and toLabor. These organizations offer referrals to their doulas.

You can also look locally. Many labor coaches advertise in the phone book or have websites. Your midwife or Ob-Gyn may have suggestions as well. You can also talk to your friends and check with breastfeeding and baby stores.

Interviewing a Labor Coach

When you find a professional labor coach you're interested in, you should interview her in person if possible. Questions to ask include the following:

  • What training and education have you received?
  • What is your philosophy about childbirth and supporting women and their partners through labor?
  • When do you join women in labor - at our home or at the place of birth?
  • Will you meet with us to discuss our birth plans and the role that you will play in supporting us through childbirth?
  • May we call you with questions or concerns before or after the birth?
  • Do you work with one or more backup doulas for times when you are not available? May we meet them?
  • What is your fee, what services does it include, and what are your refund policies?
  • Will you provide references?

It's Your Birth Experience

The goal of using a doula is to improve your birth experience; however, even with a birth coach present, remember that it is your experience and that you should be as comfortable as possible during it. Do your research so you can find the right doula for you.

Doulas and Labor Support